Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Pediatr. 2022 Nov;250:16-21.e3. doi: 10.1016/j.jpeds.2022.07.003. Epub 2022 Jul 11.
To establish a reference nomogram for end-tidal CO corrected for ambient CO (ETCOc) levels in term and late-preterm Chinese newborns and then assess its efficacy to identify hemolytic hyperbilirubinemia.
We conducted a prospective study by measuring concurrent ETCOc and total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) levels collected postnatally at 12, 24, 48, 72, 96, and 120 hours of age. ETCOc at the 25th, 50th, 75th, and 95th percentiles at each epoch were used to construct the reference nomogram. We then explored the ability of predischarge ETCOc and TSB/TcB metrics to predict the development of hyperbilirubinemia requiring phototherapy in early postnatal period and jaundice readmission in late postnatal period.
Our nomogram, based on 990 measurements from 455 infants who were not nonhemolytic, displayed a steady line within 3 postnatal days, followed by a subsequent decline. From a cohort of infants with a serial ETCOc measurements (n = 130) and those readmitted (n = 21), we found that ETCOc and TSB/TcB ≥75th percentile can identify most hemolytic hyperbilirubinemia between 12 and 72 hours after birth with an area under the curve (AUC) of 0.741. An ETCOc ≥1.7 ppm alone between 96 and 120 hours after birth can identify most hemolytic hyperbilirubinemia with an AUC of 0.816. In addition, 90.5% of readmitted infants had an ETCOc ≥75th percentile.
An ETCOc reference nomogram during the first 5 postnatal days in nonhemolytic term and late-preterm newborns can be used to identify hemolytic hyperbilirubinemia requiring phototherapy in the early postnatal period and readmission in the late postnatal period.
建立适用于足月和晚期早产儿的潮气末二氧化碳校正环境二氧化碳（ETCOc）水平的参考列线图，并评估其识别溶血性高胆红素血症的效果。
我们通过测量出生后 12、24、48、72、96 和 120 小时的 ETCOc 和总血清胆红素（TSB）或经皮胆红素（TcB）水平进行前瞻性研究。在每个时间点，使用第 25、50、75 和 95 百分位的 ETCOc 来构建参考列线图。然后，我们探讨了预测出生后早期需要光疗的高胆红素血症和晚期需要再次入院的黄疸的 ETCOc 和 TSB/TcB 指标的能力。
我们的列线图基于 990 次来自 455 名非溶血性新生儿的测量值，在出生后 3 天内显示一条稳定的线，随后下降。从 130 名有连续 ETCOc 测量值的婴儿队列和 21 名再次入院的婴儿队列中，我们发现 ETCOc 和 TSB/TcB≥75 百分位可以在出生后 12 至 72 小时内识别大多数溶血性高胆红素血症，曲线下面积（AUC）为 0.741。在出生后 96 至 120 小时之间，单独的 ETCOc≥1.7ppm 也可以识别大多数溶血性高胆红素血症，AUC 为 0.816。此外，90.5%再次入院的婴儿 ETCOc≥75 百分位。
在非溶血性足月和晚期早产儿出生后前 5 天的 ETCOc 参考列线图可用于识别出生后早期需要光疗的溶血性高胆红素血症和晚期再次入院的黄疸。
